Case Review: Spine Imaging

American Journal of Neuroradiology

Brian C. Bowen, MD, PhD. St. Louis, MO: Mosby; 2001. Price, $39.95, 247 pages.

Here’s the thing: this is a very, very good and useful book. As part of the Mosby “Case Review” series, edited by David Yousem, this publication follows their well-established didactic format. One or two interesting diagnostic images plus a brief history are presented on the right-hand page, along with some pretty hard questions. When the page is turned, the answers are provided so that the reader can check his or her knowledge, or lack thereof. Excellent discussions and pertinent references are also included, along with correlations to the full text of Mosby’s Neuroradiology: The Requesites (a clear case of successful cross-promotion that would make Madison Avenue proud).

The Case Review series seeks to duplicate the “noon conference” and “board review” techniques that have been the staple of diagnostic radiologic and neuroradiologic education for decades. It works well, particularly in the hands of author Brian Bowen, who brings an attention to detail and a love of the teaching process to this work, which is obvious on every page. Dr. Bowen and his colleagues at the University of Miami are fortunate to have a very large and active spine service with which to work, and the excellent clinicians and emergency department at Jackson Memorial Hospital provide a huge amount of pathologic material.

Dr. Bowen knows the spine and covers almost everything a reader would want to know between the soft-back covers of this book, with few exceptions. Perhaps the only thing this reviewer could think of that has been left out is a case of acute Schmorl node, but that might be personal preference and certainly represents nit-picking. Everything else seems to be included, from the mundane disk extrusion (an excellent example or three are scattered throughout the book, including some that do not even look like disks at all but turned out to be) to the truly bizarre and rare (this reviewer missed the case of Devic’s syndrome on page 19). An account of an unusual, “expansive open-door laminoplasty” in the cervical spine is included on page 219, because it looks weird and might be mistaken for something else, but the many types of orthopedic spine metallic fusion devices and disk spacers used in spine surgery today are wisely not included. Good examples of postoperative laminectomies are included, with perineural scar or recurrent disk extrusions, but hardware is not included.

The spine cases are grouped into three relatively equal size sections: “Opening Round,” “Fair Game,” and “Challenge,” which are approximately equivalent to “easy” (“basic”), “medium difficulty,” and “really tough.” All the cases represent interesting teaching points, and none are superfluous. The first two supposedly easy cases presented on page 3 turn out to include an epidural lipomatosis and a diastematomyelia with a single dural sac, so that gets the reader off to a good start. The last case presented in the book, on page 237, is one of wallerian degeneration in the cervical spine. A useful index listed by cases, in numerical order, is presented next, making it easy to look up particular cases, and a more traditional index is then provided.

This is a great teaching book. Residents and fellows will like it, especially at board review time, and experienced physicians in practice will like it to brush up on their spine diagnostic tools.